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Article history:
Received 27 February 2016
Received in revised form
1 July 2016
Accepted 24 July 2016
Available online 27 July 2016
Introduction: There are several studies about M1 type vehicle-pedestrian collision injury pattern, and
based on them, there has been several changes in automobiles for pedestrian protection. However, the
lack of sufcient studies about injury pattern in motorbikes-pedestrian collisions leads to a lack of
optimization design of these vehicles. The objective of this research is to study the injury pattern of
pedestrians involved in collisions with motorized two-wheeled vehicles.
Methods: A retrospective descriptive study of pedestrian's deaths after collisions with motorcycles in an
urban area, like Barcelona was performed. The cases were collected from the Forensic Pathology Service
database of the Institute of Legal Medicine of Catalonia. The selected cases were categorized as
pedestrian-motorcycle collision, between January 1st, 2005 and December 31st, 2014. Data were
collected from the autopsy, medical, and police report. The collected information was then analyzed
using Microsoft Excel statistical functions.
Results: Traumatic Brain Injury is the main cause of death in pedestrian hit by motorized two-wheeled
vehicles (62.85%). The most frequent injury was the subarachnoid hemorrhage, in 71.4% of cases, followed by cerebral contusions and skull base fractures (65.7%). By contrast, pelvic fractures and tibia
fractures only appeared in 28.6%.
Conclusions: The study characterizes the injury pattern of pedestrians involved in a collision with
motorized two-wheeled vehicles in an urban area, like Barcelona, which has been found to be different
from other vehicle-pedestrian collisions, with a higher incidence of brain injuries and minor frequency of
lower extremities fractures in pelvis, tibia and bula.
2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Keywords:
Pedestrian collision
Injury pattern
Motorcycles
Motorbikes
Autopsy
Traumatic brain injury
1. Introduction
Trafc accidents, including pedestrian-vehicle collisions, are one
of the leading causes of death in developed and developing countries. In 2005 in the United States more than 64,000 of the injured
people were pedestrians,1 in Germany in 2008, a total of 695 pedestrians were killed and 33.733 were injured.2 The magnitude of
the epidemiologic problem takes even more importance in developing countries, for instance in Ghana 60% of people who died by
trafc accidents were pedestrians.3 Therefore, there are many initiatives undertaken by different institutions to reduce the number
of accidents and fatalities involving pedestrians, as well as the
severity of the sustained injuries.
In recent years there has been greater awareness in relation to
the so-called vulnerable users on the road such as pedestrians,
cyclists and two-wheeled motor users.4,5 The highest incidence of
motorcycle accidents are related to the characteristics of the
vehicle, such as its high maneuverability or its great power in
relation to its weight. Moreover, its high morbidity and mortality
are due to both the driver and the passenger due to the lack of body
structure and protection in comparison to other vehicles. Additionally, it particularly affects young people, leading to a great loss
of labor capacity or loss in life years.6
http://dx.doi.org/10.1016/j.jm.2016.07.009
1752-928X/ 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
M.C. Rebollo-Soria et al. / Journal of Forensic and Legal Medicine 43 (2016) 80e84
81
Table 1
Time lapsed from the accident to the death. Note: the fatalities during the same day
include the 3 fatalities at scene.
Fatality event
Immediately/at scene
During the same day
Next day
7 days
30 days
Total
3
18
10
6
1
35
8,6
51,4
28,6
17,1
2.9
100
82
M.C. Rebollo-Soria et al. / Journal of Forensic and Legal Medicine 43 (2016) 80e84
Table 2
Causes of death and punctuation AIS for the different injuries sustained in the different anatomic regions, MAIS, ISS and NISS.
Case number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
Age
81
80
78
87
79
83
68
82
62
83
66
78
86
81
86
16
48
78
85
88
71
53
77
60
32
38
85
88
92
25
56
56
70
80
69
Gender
M
M
F
M
M
F
F
M
M
M
F
M
F
M
M
F
M
M
F
M
M
F
F
M
M
F
F
F
F
F
F
M
F
F
M
Cause of death
2
1
1
1
7
1
1
1
1
2
1
1
1
1
1
1
1
2
2
2
1
1
1
1
1
2
6
1
5
1
1
2
3
5
4
AIS
AIS
AIS
AIS
AIS
AIS
Head/neck
Face
Thorax
Abdomen
Extremities
External
0
0
0
0
0
1,2,2
0
0
0
0
0
0
0
0
0
0
0
2
2,2,3
2,2,2
2,2
0
1
0
0
2,2,2,2
4
0
0
2,2,2
2
4
2
2,2,2,2
2,4
2
0
0
0
0
2,2,2,2,2
2,2
2
0
0
0
3
2
2,2
0
0
0
2,3
2,2,4
0
0
0
0
0
2,2
2,3,3
2,2,2,2,3
0
2
0
2
2,3
4
2,2,2,3
1,1,2,3
0
2,2,3,3
2,3,3,3
2,3,3,3
2,3,3
2,2,2,3
1,2,3,3
1,2,3,3
1,2,3,3,3,4
3
2,2,3,3,3
1,1,2,2,3,3,3
3,3,3
2,2,3,3
2,2,3,3,5
1,1,2,3,3,3,3,5
2,4,5
1,2,2,3
0
1,1,2,2,2,3,4
1,1,2,2,3,3,3,5
1,1,2,3,3,5
1,1,2,2,4,5
1,1,2,2,3,4,5
1,2,3,3,4,5
1,1,2,3
1,2,2,2,3,3
1,2,2,3,3,5
1,2,2,3,3
1,2,2,3,3,4,5
1,2,3,3,3,5,5
3
1,2,3,3
1,2,2,2,4
0
0
0
0
1
1,2
0
1
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1,2
0
2
1
0
0
0
0
0
0
0
1
1
0
2
0
0
0
0
2
2
2
0
3
2,3
0
3
2,3,3
0
0
1
2,3,3,3
2,2
1,3
1
0
2
0
0
3,4
2,3,3,3
3
2,2,3,5
3
3
2,4
1,3,5
4,5
1,2,2,2,3,6
1,1,1
1,1
1,1
1,1,1,1
0
1,1,1,1
1,1,1,1,1
1,1,1,1,1,1,1
1,1,1
1,1,1
1,1,1,1
1,1,1,1,1,1,1,1,1,1
1,1
1,1,1
1,1,1,1
1,1,1,1,1,1
0
1,1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1
1,1,1,1,1,1,1,1,1
1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1
1,1,1
1,1,1,1,1
1,1
1,1,1,1,1,1,1,1,1
1,1,1,1,1,1,1,1,1,1,1,1
MAIS
ISS
NISS
2
3
3
3
3
3
3
3
4
3
3
3
3
3
5
5
5
3
4
4
5
5
5
5
5
4
4
5
5
5
5
4
5
5
6
9
10
10
11
13
17
17
17
17
19
19
19
22
22
26
26
26
27
29
29
30
30
30
30
30
34
34
35
38
38
38
41
50
50
75
9
22
27
27
22
17
22
22
34
19
27
27
27
27
43
43
45
27
29
34
43
43
45
50
50
34
34
43
43
50
59
41
50
57
75
Causes of death: 1: Traumatic Brain Injury; 2: Hemorrhage; 3: Traumatic Brain Injury and Hemorrhage; 4: Thoracic Trauma; 5: Traumatic Brain Injury and Thoracic Trauma; 6:
Abdominal Trauma; 7: Pneumonia. ISS between 9e15 is associated to moderately injured patients, 16e24 for severely injured and 25e75 for critically injured.
Table 3
Sustained injuries distributed by anatomic region.
Anatomic region
Type of injury
Frequency % (n)
Head
34.29 (12)
65.71 (23)
71.43 (25)
54.29 (19)
8.57 (3)
65.71 (23)
22.86 (8)
22.86 (8)
31.43 (11)
8.57 (3)
45.71 (16)
14.29 (5)
8.57 (3)
20.0 (7)
17.14 (6)
17.14 (6)
5.71 (2)
8.57 (3)
5.71 (2)
14.29 (5)
5.71 (2)
8.57 (3)
8.57 (3)
2.86 (1)
28.57 (10)
20.0 (7)
28.57 (10)
Face
Thorax
Abdomen
Spine
Upper extremities
Lower extremities
M.C. Rebollo-Soria et al. / Journal of Forensic and Legal Medicine 43 (2016) 80e84
accidents in general, but not specically to the ones involving pedestrians hit by motorcycles, or at least they don't distinguish between vehicles.1,2,11,12
In our study, as in most studies on accidents1,3,11,12, most people
hit by a car were male, as contrast with the study of Ehrlich et al.13
where a predominance of female were found.
Our mean age was much higher than that of other studies, such
as Peng et al.12 with 27.6 0.3 years or the one of Schmucker et al.2
with 37.1 years. In the study of Ehrlich et al.,13 the age average for
women was similar to our study, 69 years on average, with cases
reported between 16 and 91 years, and in our study 67.4 22.7
years on average with cases from 16 to 92 years.
Most of the injured died in hospital (91.4%). Those who survived
beyond 24 h, had a median stay of 4 days, which coincides with the
median of hospital stay in the study by Starnes et al.1
In the present study, the most common cause of death was the
TBI, a fact that coincides with the study Schmucker et al.2 In both
studies, the most common injuries were subarachnoid hemorrhage
and brain contusions. In our case, this may be because the cases
studied are fatalities and the injuries of higher mortality are those
located on the head. In other studies present in the literature the
most frequent injuries were in muscle-skeletal12 system, above all
in lower extremities, not only in developed countries, as the United
States of America1,11 or European14 countries but also in developing
countries such as India.15 This could be explained because our data
were collected from forensic data not from hospital reports like in
these studies.
In lower limb injuries, the most common fractures were the
pelvis (28.57%), this is more frequent than in the study of Siram
et al.11 where they represent 9.2%, or in the study performed by
Starnes et al.1 where they represent 14.4%, which also reected a
higher incidence of pelvic fractures in women than in men. In our
case pelvis fracture appears in 10 cases out of 35, in 6 women and 4
men. The higher frequency may be due to the location of the vehicle
with which the collision occurs. In accidents with utility vehicles,
pelvic fractures usually occur when the pelvis hits against the
hood,7 in the wrap around the vehicle, resulting in a reduction in
collision speed and a greater area of impact, therefore reducing the
pelvic load. In contrast, in the case of accidents for two-wheeled
vehicles, the collision occurs in the front area of the vehicle so
that there is a direct impact against the pelvic area, without the
speed reduction; and due to the small surface of contact this causes
stress concentration to the pelvic area. This could explain both the
increased frequency of fractures of the pelvis and lower frequency
of fractures of the tibia and bula as well as knee injuries. Fractures
of tibia and bula, so prevalent in bumper injuries, in our study
were only found in 28.57% and 20% respectively, similar to the
study of Starnes et al.1 which shows a percentage of tibial fractures
of 27.3%. On the other hand in the study of Schmucker2 these
fractures appear in 40.54% of cases, but it recognizes the need to
further investigate the mechanism of fracture of tibia and bula
since in many cases these lesions appear on the contralateral leg.
Thus, the mechanism of injury is not completely identied so far.
The most common chest injuries where rib fractures, a fact that
coincides with the study of Schmucker et al.2 The major abdominal
injuries in this study were in liver and spleen. In our study, however, although liver lesions are the most frequent, the spleen ones
are more infrequent, appearing only in 8.5% of cases.
The ISS average found in the study of Peng et al.12 was 24.5 1.0
in dead people, which is 2 units lower than in our study, while in the
research performed by Schmucker et al.2 was 31, Schmucker acknowledges that the ISS is in the upper limit compared to other
studies (9e34) since they have excluded cases produced at a speed
under 20 km/h. In our study, it is also reasonable that the ISS was
observed at the upper limit since only have been studied cases
83
84
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trafc crash victims at Bigando Medical Centre in Northwestern Tanzania.
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Encyclopedia of Automotive Engineering. ISBN: 978-0-470-97402-5. pp.
3049e3072.
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country and the vulnerability of riders, passengers, and pedestrians. Inj Prev.
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n Narro J. Proteccio
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5,000 patients. J Am Coll Surg. 1999;189:343e348.
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Berlin Changed injury patterns in two different time intervals. Leg Med.
2009;11:324e326.
14. Arregui-Dalmases C, Lopez-Valdes FJ, Segui-Gomez M. Pedestrian injuries in
eight European countries: an analysis of hospital discharge data. Accid Anal
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